Concerns over national policy on infertility treatment

Decisions about providing fertility treatment on the NHS should be made locally according to need and priority, rather than through national policy, argues a leading medical ethicist in this week's BMJ.

His comments follow guidelines by the National Institute of Clinical Excellence (NICE) that all couples meeting certain criteria should have up to three cycles of in vitro fertilisation free on the NHS.

The debate about publicly funding assisted conception is in essence a debate about values and priorities rather than a debate about what works, writes Richard Ashcroft of Imperial College London. Under a publicly funded NHS it is a political decision, not a clinical one, about how far we as a society want to provide fertility services and to whom.

Even with these guidelines it is unclear whether the government will ensure that appropriate resources are made available centrally. It is more likely that the guidelines will simply have to fit into existing locally made spending plans, he adds.

The guidelines from NICE temper local arbitrariness and unfairness, but they also tie the hands of the local decision makers whose job it is to set priorities.

We should be wary of making reproduction a major theme in our national politics, he warns. As long as people have reliable information and decision makers are accountable for the reasonableness of their decisions, why should there be national policy?

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